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Insurance companies up to their old tricks?

August 20, 2014

You had to see this coming.

Those who look out for the rights and needs of health care recipients are sounding the alarm that insurance companies are, once again, trying to make it difficult for patients to get the care and medicines they need.

According to a recent Associated Press report, hundreds of patient advocacy groups have written to Health and Human Services Secretary Sylvia Mathews Burwell to warn that some tactics being used by insurance companies “are highly discriminatory against patients with chronic health conditions and may … violate the (Affordable Care Act’s) nondiscrimination provisions.”

As we know, a centerpiece of President Obama’s ACA, or Obamacare, as it is called by some, is to prevent insurers from denying care to people with chronic ailments and pre-existing conditions.

But groups such as the AIDS Institute, the American Lung Association, Easter Seals and United Cerebral Palsy contend barriers are being thrown up by insurers, especially when it comes to patients seeking coverage for expensive medications.

In Washington state, Insurance Commissioner Mike Kreidler, a Democrat, told the AP there is “no question” the insurance companies are backsliding. “The question is whether we’re catching it or not,” he said.

The insurance commissioner in Kansas, Republican Sandy Praeger, wasn’t willing to go as far as Kreidler, but she said vigilance is necessary on the part of the Obama administration.

“They ought to make it very clear that if there is any kind of discrimination against people with chronic conditions, there will be enforcement action,” she told the AP. “The whole goal here was to use the private insurance market to create a system that provides health insurance for all Americans.”

Specific complaints from the patient advocate organizations include:

• Difficulties faced by consumers trying to get full information about plans sold on the new insurance exchanges;

• Limited networks of hospitals and doctors available to patients under insurance plans;

• High co-pays for patients who require expensive prescriptions.

America’s Health Insurance Plan, the largest industry trade organization, argues discrimination doesn’t exist, because patients have a wide range of options for coverage that best suits their needs.

But law professor Timothy Jost of Washington and Lee University in Virginia said the bottom line is “people who have high-cost health conditions are still having a problem accessing care.”

“We are in the early stages of trying to figure out what the problems are, and to what extent they are based on insurance company discrimination, or inherent in the structure of the program,” he said.

The biggest problem, as we see it, is the ACA was not the best option from the beginning for seeing that all Americans have affordable access to quality health care. It was what the president could get through Congress. The best option would have been creation of a single-payer system, or essentially extending Medicare to all. Absent that, the law should have provided a so-called public option, a government-run program to compete against the private insurance companies. But that was tossed aside in the effort to get something – anything – approved.

You might be asking, “Weren’t the insurance companies supportive of the ACA?” Well, not really. National Journal magazine reported a couple of years ago that at the same time America’s Health Insurance Plans was publicly backing the president’s efforts, it was funneling more than $100 million to the U.S. Chamber of Commerce’s efforts to defeat the ACA. And the spending on influence continues. Last year, the insurance industry, as a whole, spent more than $78 million on lobbying.

If what the patient advocacy organizations are saying now about the insurance companies is true, can we count on our Congress to side with sick people, or with those who finance their re-election campaigns? We already know the answer to that.